Effect of COVID-19 Vaccine Messaging Platforms in Emergency Departments on Vaccine Acceptance and Uptake
Authors: Robert M. Rodriguez, Graham Nichol, Stephanie A. Eucker, Anna Marie Chang, Kelli N. O’Laughlin, Alena Pauley, Kristin L. Rising, Vidya Eswaran, Dana Morse, Cindy Li, Ashini Patel, Herbie C. Duber, Mireya Arreguin, Lindsey Shughart, Dave Glidden, Hemal Kanzaria, Jonathan Butler, Robin Kemball, Virginia Chan, Cecilia Lara-Chavez, Amanda Guth, Iyaniwura Olarewaju, Sophie C. Morse, Ashini Patel, Kevin Schaeffer, Dylan Grau, Abir Arab, Anna Tupetz, Erica Walker, Phillip Watts, Hailey Shughart, Bryan Yan, Sophie Finkelstein, Harrison Chen, Nikki Daniels, Jaran White, Joshua Sarafian, Lauren Howard, Lea Alali, Glory Agun, Emmanuel A. Chan, Anna Covington, Chris Klasson
Journal: JAMA Internal Medicine (2022)

Importance Large segments of the US population’s primary health care access occurs in emergency departments (EDs). These groups have disproportionately high COVID-19 vaccine hesitancy and lower vaccine uptake. Objective To determine whether provision of COVID-19 vaccine messaging platforms in EDs increases COVID-19 vaccine acceptance and uptake in unvaccinated patients. Design, Setting, and Participants This prospective cluster randomized clinical trial was conducted at 7 hospital EDs in 4 US cities from December 6, 2021, to July 28, 2022. Noncritically ill adult patients who had not previously received COVID-19 vaccines were enrolled. Interventions A 3-pronged COVID-19 vaccine messaging platform (an English- or Spanish-language 4-minute video; a 1-page informational flyer; and a brief, scripted message from an ED physician or nurse) was delivered during patient waiting times. Main Outcomes and Measures The 2 primary outcomes were (1) COVID-19 vaccine acceptance, assessed by survey responses in the ED, and (2) receipt of a COVID-19 vaccine within 30 days, ascertained by ED confirmation of vaccination, electronic health record review, and telephone follow-up. Results Of the 496 participants enrolled (221 during intervention weeks and 275 during control weeks), the median (IQR) age was 39 (30-54) years, 205 (41.3%) were female, 193 (38.9%) were African American, 97 (19.6%) were Latinx, and 218 (44.0%) lacked primary care physicians. More intervention group participants, compared with control participants, stated that they would accept the vaccine in the ED (57 [25.8%] vs 33 [12.0%]; adjusted difference, 11.9 [95% CI, 4.5-19.3] percentage points; number needed to treat [NNT], 8 [95% CI, 5-22]). More intervention group participants than control participants received a COVID-19 vaccine within 30 days of their ED visit (44 [20.0%] vs 24 [8.7%]; adjusted difference, 7.9 [95% CI, 1.7-14.1] percentage points; NNT, 13 [95% CI, 7-60]). The intervention group had greater outcome effect sizes than the control group in participants who lacked a primary care physician (acceptance, 38 of 101 [37.6%] vs 16 of 117 [13.7%] [ P for interaction = .004]; uptake, 31 of 101 [30.7%] vs 11 of 117 [9.4%] [ P for interaction = .006]), as well as in Latinx persons (acceptance, 23 of 52 [44.2%] vs 5 of 48 [10.4%] [ P for interaction = .004]; uptake, 22 of 52 [42.3%] vs 4 of 48 [8.3%] [ P for interaction &amp;amp;lt; .001]). Conclusions and Relevance Results of this cluster randomized clinical trial showed that with low NNT, implementation of COVID-19 vaccine messaging platforms in EDs leads to greater vaccine acceptance and uptake in unvaccinated ED patients. Broad implementation in EDs could lead to greater COVID-19 vaccine delivery to underserved populations whose primary health care access occurs in EDs. Trial Registration ClinicalTrials.gov Identifier: NCT05142332